Research Article| Volume 65, ISSUE 7, P875-882, July 2012

Transzygomatic Kirschner wire fixation for the treatment of blowout fracture

Published:February 28, 2012DOI:



      Total orbital floor reconstruction with sheet-shape materials is available for the treatment of extensive and crushed-type blowout fractures. Simple blowout fractures, on the other hand, require only manual reduction without fixation. Although several types of blowout fractures do not require total reconstruction, some fixation is usually necessary.


      Eighteen cases of blowout fracture were treated with transzygomatic Kirschner wire fixation between 2002 and 2009. This technique was applied to simple fracture cases in which periorbital soft tissue re-herniated through the floor defect into the maxillary sinus after manual reduction, despite improvement of the extra-ocular muscle entrapment. The wire was used to directly support the fracture segment in five cases and used together with a maxillary sinus anterior wall bone graft in 13 cases.


      Mean follow-up was 12.5 months. Mild diplopia remained as a subjective symptom in one case. None of the cases developed major complications or conspicuous scars on the cheek.


      Transzygomatic Kirschner wire fixation for blowout fracture has the advantages of precise and rigid fixation of all parts of the inferior floor, minimal morbidity without requiring an orbital approach and long-term safety without artificial remnants. This technique can be applied for the treatment of simple blowout fractures.


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        • Fujino T.
        • Makino K.
        Entrapment mechanism and ocular injury in orbital blowout fracture.
        Plast Reconstr Surg. 1980; 65: 571-574
        • Kaufman Y.
        • Stal D.
        • Cole P.
        • Hollier Jr., L.
        Orbitozygomatic fracture management.
        Plast Reconstr Surg. 2008; 121: 1370-1374
        • Guo L.
        • Tian W.
        • Feng F.
        • Long J.
        • Li P.
        • Tang W.
        Reconstruction of orbital floor fractures: comparison of individual prefabricated titanium implants and calvarial bone grafts.
        Ann Plast Surg. 2009; 63: 624-631
        • Al-Sukhun J.
        • Lindqvist C.
        A comparative study of 2 implants used to repair inferior orbital wall bony defects: autogenous bone graft versus bioresorbable poly-L/DL-Lactide [P(L/DL)LA 70/30] plate.
        J Oral Maxillofac Surg. 2006; 64: 1038-1048
        • Garibaldi D.C.
        • Iliff N.T.
        • Grant M.P.
        • Merbs S.L.
        Use of porous polyethylene with embedded titanium in orbital reconstruction: a review of 106 patients.
        Ophthal Plast Reconstr Surg. 2007; 23: 439-444
        • Prowse S.J.
        • Hold P.M.
        • Gilmour R.F.
        • Pratap U.
        • Mah E.
        • Kimble F.W.
        Orbital floor reconstruction: a case for silicone. A 12 year experience.
        J Plast Reconstr Aesthet Surg. 2010; 63: 1105-1109
        • Park D.J.
        • Garibaldi D.C.
        • Iliff N.T.
        • Grant M.P.
        • Merbs S.L.
        Smooth nylon foil (SupraFOIL) orbital implants in orbital fractures: a case series of 181 patients.
        Ophthal Plast Reconstr Surg. 2008; 24: 266-270
        • Sakakibara S.
        • Hashikawa K.
        • Terashi H.
        • Tahara S.
        Reconstruction of the orbital floor with sheets of autogenous iliac cancellous bone.
        J Oral Maxillofac Surg. 2009; 67: 957-961
        • Talesh K.T.
        • Babaee S.
        • Vahdati S.A.
        • Tabeshfar S.H.
        Effectiveness of a nasoseptal cartilaginous graft for repairing traumatic fractures of the inferior orbital wall.
        Br J Oral Maxillofac Surg. 2009; 47: 10-13
        • Kim J.H.
        • Kook M.S.
        • Ryu S.Y.
        • Oh H.K.
        • Park H.J.
        A simple technique for the treatment of inferior orbital blow-out fracture: a transantral approach, open reduction, and internal fixation with miniplate and screws.
        J Oral Maxillofac Surg. 2008; 66: 2488-2492
        • Burm J.S.
        Internal fixation in trapdoor-type orbital blowout fracture.
        Plast Reconstr Surg. 2005; 116: 962-970
        • Strong E.B.
        Endoscopic repair of orbital blow-out fractures.
        Facial Plast Surg. 2004; 20: 223
        • Furuta M.
        Measurement of orbital volume by computed tomography: especially on the growth of orbit.
        Jpn J Opthalmol. 2001; 45: 600-606
        • Adams V.M.
        Internal wiring fixation of facial fractures.
        Surgery. 1942; 12: 523-540
        • Michelet F.X.
        • Deymes J.
        • Dessus B.
        Osteosynthesis with miniaturized screw plants in maxillofacial surgery.
        J Maxillofac Surg. 1973; 1: 79-8416
        • Mavili M.E.
        • Canter H.I.
        • Tuncbilek G.
        Treatment of noncomminuted zygomatic fractures with percutaneous screw reduction and fixation.
        J Craniofac Surg. 2007; 18: 67-73
        • Bezuhhly M.
        • Lalonde J.
        • Lalonde D.H.
        Gillies elevation and percutaneous Kirschner wire fixation in the treatment of simple zygoma fractures: long-term quantitative outcomes.
        Plast Reconstr Surg. 2008; 121: 948-955
        • Soejima K.
        • Sakurai H.
        • Kono T.
        • et al.
        Semi-closed reduction of tripod fractures of zygoma under intraoperative assessment using ultrasonography.
        J Plast Reconstr Aesthet Surg. 2009; 62: 499-505
        • Lothrop H.A.
        Fractures of the superior maxillary bone caused by direct blows over the malar bone.
        Boston Med Surg J. 1906; 154: 8-11
        • Gillies H.D.
        • Kilner T.P.
        • Stone D.
        fractures of the malar zygomatic compound, with a description of a new X-ray position.
        Br J Surg. 1927; 14: 651-656
        • Ducic Y.
        • Verret D.J.
        Endoscopic transantral repair of orbital floor fractures.
        Otolaryngol Head Neck Surg. 2009; 140: 849-854
        • Chen C.T.
        • Chen Y.R.
        Endoscopically assisted repair of orbital floor fractures.
        Plast Reconstr Surg. 2001; 108: 2011-2018
        • Farewell D.G.
        • Sires B.S.
        • Kriet J.D.
        • Stanley Jr., R.B.
        Endoscopic repair of orbital blowout fracture: Use or misuse of a new approach?.
        Arch Facial Plast Surg. 2007; 9: 427-433
        • Ridgway E.B.
        • Chen C.
        • Colakoglu S.
        • Gautam S.
        • Lee B.T.
        The Incidence of lower eyelid malposition after facial fracture repair: a retrospective study and meta-analysis comparing subtarsal, subciliary, and transconjunctival incisions.
        Plast Reconstr Surg. 2009; 124: 1578-1586
        • Kim Y.K.
        • Kim J.W.
        Evaluation of subciliary incision used in blowout fracture treatment: pretarsal flattening after lower eyelid surgery.
        Plast Reconstr Surg. 2010; 125: 1479-1484
        • Kennedy D.W.
        • Goodstein M.L.
        • Miller N.R.
        • Zinreich S.J.
        Endoscopic transnasal orbital decompression.
        Arch Otolaryngol Head Neck Surg. 1990; 116: 275-282
        • Yamaguchi N.
        • Arai S.
        • Mitani H.
        • Uchida Y.
        Endoscopic endonasal technique of the blowout fracture of the medial orbital wall.
        Op Tech Otolaryngol Head Neck Surg. 1992; 2: 269-274
        • Lee H.H.
        • Alcaraz N.
        • Reino A.
        • et al.
        Reconstruction of orbital floor fractures with maxillary bone.
        Arch Otolaryngol Head Neck Surg. 1998; 124: 56-5929
        • Folkestad L.
        • Westin T.
        Long-term sequelae after surgery for orbital floor fractures.
        Otolaryngol Head Neck Surg. 1999; 120: 914-921
        • Nishiike S.
        • Nagai M.
        • Nakagawa A.
        • Harada T.
        Endoscopic transantral orbital floor repair with antral bone grafts.
        Arch Otolaryngol Head Neck Surg. 2005; 131: 911-915,
        • Nahlieli O.
        • Bar-Droma E.
        • Zagury A.
        • et al.
        Endoscopic intraoral plating of orbital floor fractures.
        J Oral Maxillofac Surg. 2007; 65: 1751-1757
        • Persons B.L.
        • Wong G.B.
        Transantral endoscopic orbital floor repair using resorbable plate.
        J Craniofac Surg. 2002; 13: 483-488
        • Cheong E.C.
        • Chen C.T.
        • Chen Y.R.
        Broad application of the endoscope for orbital floor reconstruction: long-term follow-up results.
        Plast Reconstr Surg. 2010; 125: 969-978
        • Thorén H.
        • Snäll J.
        • Kormi E.
        • Lindqvist C.
        • Suominen-Taipale L.
        • Törnwall J.
        Symptomatic plate removal after treatment of facial fractures.
        J Craniomaxillofac Surg. 2010; 38: 505-510
        • Nagase D.Y.
        • Courtemanche D.J.
        • Peters D.A.
        Plate removal in traumatic facial fractures: 13-year practice review.
        Ann Plast Surg. 2005; 55: 608-611
        • Lee H.B.
        • Nunery W.R.
        Orbital adherence syndrome secondary to titanium implant material.
        Ophthal Plast Reconstr Surg. 2009; 25: 33-36
        • Warrier S.
        • Prabhakaran V.C.
        • Davis G.
        • Selva D.
        Delayed complications of silicone implants used in orbital fracture repairs.
        Orbit. 2008; 27: 147-151
        • Uygur S.
        • Cukurluoglu O.
        • Ozmen S.
        • Guclu T.H.
        • Sezgin B.
        Resorbable mesh plate in the treatment of blow-out fracture might cause gaze restriction.
        J Craniofac Surg. 2009; 20: 71-72
        • Mohadjer Y.
        • Hartstein M.E.
        Endoscopic orbital fracture repair.
        Otolaryngol Clin North Am. 2006; 39: 1049-1057
        • Woog J.J.
        • Hartstein M.E.
        • Gliklich R.
        Paranasal sinus endoscopy and orbital fracture repair.
        Arch Ophthalmol. 1998; 116: 688-691
        • Hinohira Y.
        • Yumoto E.
        • Shimamura I.
        Endoscopic endonasal reduction of blowout fractures of the orbital floor.
        Otolaryngol Head Neck Surg. 2005; 133: 741-747
        • Miki T.
        • Wada J.
        • Haraoka J.
        • Inaba I.
        Endoscopic transmaxillary reduction and balloon technique for blowout fractures of the orbital floor.
        Minim Invasive Neurosurg. 2004; 47: 359-364

      Linked Article

      • Treatment of blowout fracture: Optimal treatment modality yet to be found?
        Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 65Issue 7
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          with great interest I have read the article “Transzygomatic Kirshner Wire Fixation for the Treatment of Blowout Fracture.” by K Yasumura et al.1 The authors share their experience in treating blowout fractures with a new technique using a transantral approach for bony repositioning and a stab incision in the cheek for Kirshner wire insertion through the zygomatic body into the maxillary sinus for pinpoint support. However, as the authors indicate, this antral approach is not always sufficient, e.g.
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